Permit N /0/5to$ , --� &,.—._ •
'''' ' CITY ,0 TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00251
TiGA 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/5/2008
PARCEL: 1S133AD-15300
SITE ADDRESS: 11143 SW SUMMER LAKE DR ZONING: R - 7
SUBDIVISION: SUMMER LAKE LOT: 034 JURISDICTION: TIG
PROJECT: MCNEILL
Project Description: Installing approximately 40' of rain drain.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: 0
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 40 ft
Owner: FEES
RANDY MCNEILL
11143 SW SUMMER LAKE DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 6/5/2008 $72.50
[TAX] 12% State Surch 6/5/2008 $8.70
Phone : 503 -317 -9555 Total $81.20
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : PRI
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued : / _ 0 / i - / Permittee Signat e: ,�j ( '
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
a CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00251
T►cAitp 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/5/2008
PARCEL: 1S133AD-15300
SITE ADDRESS: 11143 SW SUMMER LAKE DR ZONING: R - 7
SUBDIVISION: SUMMER LAKE LOT: 034 JURISDICTION: TIG
PROJECT: MCNEILL
Project Description: Installing rain drain.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: 1
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
RANDY MCNEILL
11143 SW SUMMER LAKE DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 6/5/2008 $72.50
[TAX] 12% State Surch 6/5/2008 $8.70
Phone : 503- 317 -9555 Total $81.20
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : PRl
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
40e
Se.4V
Issued B ! Permittee Signature: 1'
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
I
Plumbing Permit Application
Building Fixtures S INV FOR OFFICE USE ONLY
City of Tigard n Received Permit No.: /LA �,, p
'∎-• Date/By: 6/S c 6 !- t vW d �.�
•
13125 SW Hall Blvd., Tigard, OR 97223 Q 5 Plan Review 1 /
' lig C : Phone 503.639.4171 Fax: 503.598.19V" rr tp Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 a U XSll�� Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov 0. s`r �1� \J Notified/Method: Supplemental Information vt "
TYPE OF WORIj�v ,,v 1J FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. I Total
. Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 111q-z, Sw so A 1V1 t. R C-A k- } t Catch basin or area drain 16.60
City /State /ZIP: I I G Pfe a 7-L7_, Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: is lk r/ Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes, t 16.60
sV4 No- Iiit(u;A 'I
2 izy Rain drai
/ n connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: &14,1 tM` Lia let PA dA L I Lot no.: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK /� Backflow preventer Page 2
u , E fl l Pte! bIlP J k)S TO 611,L7 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: A An3n 14,4 (,i\ i LIA_ Expansion tank 16.60
Address: A Ag t)E- Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
F ax: Garbage disposal 16.60
Phone: (503) 3 ! 7 � S� - � ( )
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 1 6.60
Sink/basin/lavatory 16.60
Phone: ( ) Fax:: ( ) I
Tub /shower /shower pan ( t/ 16.60
E -mail: Urinal h t� 16.60
CONTRACTOR Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 5 7
CCB Lic.: / Plumbing Lic. no.: Plan review (25% of permit fee)
/ State surcharge (12% of permit fee) Authorized signal ��// TOTAL PERMIT FEE •/,,i./D
Print name: PA ..1 • ill Gl 116 j� Date: ( / 0j/ This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:\Building\Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10/02 /COM/WEB)
- r
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - l' 100' 55.00 0 to 2,000 $ 1 15.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm &Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Q ty. Fee (ea) Total additional $100.00 or fraction thereof, to and
Fixture or Item including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling l 65.25 (6--;).-3 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
- 4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\ Building \Permits\PLM- PermitApp.doc 12/27/06
M . CITY OF TIGARD PLUMBING PERMIT
• ° `• COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00251
TIGnttD` 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/5/2008
PARCEL: 1S133AD-15300
SITE ADDRESS: 11143 SW SUMMER LAKE DR ZONING: R -7
SUBDIVISION: SUMMER LAKE LOT: 034 JURISDICTION: TIG
PROJECT: MCNEILL
Project Description: Installing rain drain.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: 1
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
RANDY MCNEILL
11143 SW SUMMER LAKE DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 6/5/2008 $72.50
[TAX] 12% State Surch 6/5/2008 $8.70
Phone : 503- 317 -9555 Total $81.20
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : PRI
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
,-- 1 11° se_
Issued B -` ��_ •- Permittee Signature:
/�
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Information Notice to Property Owners About
Construction Responsibilities Statement
Oregon Law requires residential construction permit applicants who are not licensed
with the Construction Contractors Board to sign the following statement before a
building permit can be issued. [ORS 701.055 (4)]
This statement is required for residential building, electrical, mechanical and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Please check the appropriate box and complete the following statement:
1 own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
1 will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
N, I will be performing work on property 1 own, a residence that 1 reside in or a residence that 1 will
reside in. If 1 hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If 1 change my mind and hire a general contractor, I will contract with a
contractor who is licensed with the CCB and will immediately notify the office issuing this building
permit of the name of the contractor.
I have read and understand the Information Notice to Property Owners about Construction
Responsibilities contained on these two pages and I hereby certify that the information checked and
completed above is correct and accurate.
i<A/or M e Akd - ..--cair,
... e,‘„
Print name of permit applicant Signature .f permit oplicant
Date
Perm it # : , Z KA= Gv-� P7 x 900 ( 5` -cry
This form is supplied to building • � //7`�3 � �
� �m� L h a
permit offices by the Oregon, address:
Construction Contractors Board, ; • • �i ci 1
as required by ORS 701.055 (6) ` /
,---
Issued by: 17 Date: r
This copy to issuing permit office
CITY OF TIGARD - �j
BUILDING DIVISION PERMIT #:7 -' // �o(��00257
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: I
Phone: (503) 639 -4171 �..��� ,,'' i� ��� � � J
Inspection Requests (24 Hrs.): (503) 639 -4175 N
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / 1/ 4 /3 6 /4V \J1/ ' - 111 CLASS OF WORK:
SUBDIVISION: �` / �/�,�' ^ LOT #: TYPE OF USE:
PROJECT NAME: / / 1, ' A \J /
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
317 i t___—
Corrections /Comments/ Instructions:
A f
2< PASS ❑ PART. L APPROVAL n CANCEL NO ACCESS
n FAIL • 1 L Fo R I : e 1' DDITIO L FEES SESSED
- I 0 Inspector: Date: Phone #: (503) 71 s � �
CITY OF TIGARD , _
BUILDING DIVISION PERMIT, r_094.),
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 F �I(L
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: C (0 D TIME: PAGE:
SITE ADDRESS: / 8,13 6V CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
�L' 1 ---C
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
33j ),, e4
Corrections /Comments / Instructions:
'' / L.,.-c, e'.1 ( r P eL.-S A r‘ c.._____ 74,
I-0 do Gc?LC S. l> ., Lc., ire- � v2 AA/
/
cr
PASS • PARTIAL APPR•VAL 111 -NCEL 1 1 NO ACCESS
F AIL i C L :,4eR 1 SPECTION ADDITIONAL FEES ASSESSED
____
or
Inspector: Date: 6 / ° Phone #: (503) 71 -